The bare minimum of information at discharge after acute coronary syndrome. Part 2: the quality improvement project

An Acute Coronary Syndrome is a fine example of the communicative difficulties that precede and characterize hospital discharge. In recent years, due to the rapid changes in therapeutic approaches, hospitalizations have become extremely brief. This entails the risk of inadequate information at discharge, significantly affecting the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. There are a series of issues that the health practitioner should cover at discharge with the patient and family members: history of disease and prognosis, risk factors and strategies for their control, aims of treatment, instructions on drugs, diet and physical activity, need for medical check-up; and, last but not least, to verify that the information has been understood. Information on drug treatment is all too often left to patient’s interpretation of hearsay or of the discharge letter, the new drug regime can easily be misunderstood or arbitrarily integrated into pre-existing drug regimes. Health practitioners must discuss issues, regardless of whether they are asked direct questions; and they should verify what imparted information has been correctly understood and assimilated. A rapid turn-over is crucial to the organization of acute units, therefore we need to identify a solution that ticks all the boxes of a good discharge in a reasonably brief time. Imparting information should be an integral component of care delivery, and the responsible practitioners (doctors and/or nurses) should be identified. We propose a standardized discharge form, containing the essential information, as a point of reference to be applied in different clinical settings.